Clinical outcomes and adherence to topical corticosteroid therapy in women with vulvar lichen sclerosus: A retrospective cohort study.

BACKGROUND: Vulvar lichen sclerosus is a progressive dermatitis with significant itching, pain, and sexual dysfunction. OBJECTIVE: To investigate topical steroid use and clinical improvement across multiple specialties. METHODS: Retrospective cohort study at dermatology, gynecology, and vulvovaginal specialty clinics from 2012 to 2017. Descriptive statistics and panel logistic regression were performed. RESULTS: A total of 333 women attended 1525 visits (median 6/patient; range, 1-24 visits). Patients used steroids exactly as prescribed at 66% of visits, less than prescribed at 26%, and not at all at 8%. Versus no use, exact use improved symptoms (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.2-9.6) and physical examination findings (OR, 6.9; 95% CI, 2.7-17.6) more than infrequent steroid use (symptoms: OR, 2.5; 95% CI, 1.2-5.4; physical examination findings: OR, 4.2; 95% CI, 1.6-11.0). Sexual activity status was noted in 93% of vulvovaginal, 29% of gynecology, and 0% of dermatology visits. At intake, 42% of women were sexually inactive because of pain; of these, 37% became sexually active after steroid treatment. Steroid adherence was not associated with change in sexual activity. CONCLUSIONS: Women with vulvar lichen sclerosus improve more when topical steroids are used exactly as prescribed, although some improvement occurs with imperfect use. Sexual activity documentation is inconsistent, limiting quality of life follow-up.

Brown-gray hyperpigmentation in a photosensitive distribution after levofloxacin exposure.

Photosensitive drug reactions resulting in hyperpigmentation occur when there is an accumulation in the skin of melanin, heavy metals, or the drug itself. Herein we describe an immunocompromised orthotopic liver transplant patient with levofloxacin-induced hyperpigmentation with iron deposition. To identify the causal agent, consideration was given to medications the patient had taken long-term, as well as medications introduced more recently before the event. Levofloxacin and posaconzole emerged as the most likely culprit drugs, neither of which have a strong history in the literature of being associated with photosensitive hyperpigmentation. Levofloxacin was determined to be the culprit drug when the hyperpigmentation gradually resolved several weeks after discontinuation of levofloxacin, with continuation of posaconazole and all other long-term medications. This case highlights the challenges in identifying the causal agent in photosensitive drug reactions when patients are taking multiple medications. Key clinical data can be very helpful in making an assessment.